Zusammenfassung
Mit zunehmendem Lebensalter verliert der Mensch Muskelkraft und Muskelmasse. Akute Erkrankungen, Operationen oder chronische Krankheiten können aber rasch zu ungewollter Immobilität und noch mehr Muskelverlust führen. Dabei besteht für den älteren Menschen die Gefahr der Verringerung der Funktionalität und Alltagskompetenz. Sarkopenie bezeichnet dieses Syndrom, das durch einen progressiven und generalisierten Verlust von Muskelmasse und -kraft mit negativen Folgen wie Funktionseinschränkungen und Gebrechlichkeit gekennzeichnet ist. Bei schweren Erkrankungen oder operativen Eingriffen macht sich dies besonders in der verlängerten Rekonvaleszenz bemerkbar. Die Sarkopenie geht mit reduzierter Lebensqualität und erhöhter Mortalität einher. Es ist wichtig, mit Hilfe von gezielten Anamnesefragen und klinischen Funktionsuntersuchungen die Sarkopenie zu diagnostizieren und adäquate Interventionen, wenn möglich bereits beispielsweise präoperativ, in die Wege zu leiten. Entscheidend ist hierbei, dass neben der Behandlung der Grundkrankheit immer auf die Kombination von ausgewogener, proteinreicher Ernährung und entsprechendem körperlichen Training geachtet wird. Nur die Einzelkomponenten oder gar der der Ansatz der medikamentösen Therapie sind nicht zielführend.
Abstract
With increasing age, people lose muscle strength and muscle mass. Acute illnesses, surgical interventions or chronic illnesses can quickly lead to immobility and even more muscle loss. For the elderly, there is a risk of reduced functionality and everyday skills. This syndrome, referred to sarcopenia, is characterized by a progressive and generalized loss of muscle mass and strength with negative consequences such as functional impairment and frailty. In the case of serious illnesses or surgical interventions, this is particularly noticeable in prolonged convalescence. Sarcopenia is associated with reduced quality of life and increased mortality. It is important to diagnose sarcopenia with the help of specific anamnesis questions and clinical functional examinations and to initiate adequate interventions, if possible preoperatively, for example. In addition to treating the underlying disease, it is crucial to always pay attention to the combination of a balanced protein-rich diet and appropriate physical training. Use of only one of the components or even the drug therapy approach is not effective.
Literatur
Cruz-Jentoft AJ, Sayer AA (2019) Sarcopenia. Lancet 393:2636–2646
Shaw SC, Dennison EM, Cooper C (2017) Epidemiology of sarcopenia: determinants throughout the lifecourse. Calcif Tissue Int 101:229–247
Münzer T (2010) Sarkopenie im Alter. Schweiz Med Forum 10:188–190
Koster A, Visser M, Simonsick EM et al (2010) Association between fitness and changes in body composition and muscle strength. J Am Geriatr Soc 58:219–226
Drey M, Krieger B, Sieber CC et al (2014) Motoneuron loss is associated with sarcopenia. J Am Med Dir Assoc 15:435–439
Sergi G, De Rui M, Veronese N et al (2015) Assessing appendicular skeletal muscle mass with bioelectrical impedance analysis in free-living Caucasian older adults. Clin Nutr 34:667–673
Strasser EM, Draskovits T, Praschak M et al (2013) Association between ultrasound measurements of muscle thickness, pennation angle, echogenicity and skeletal muscle strength in the elderly. Age 35:2377–2388
Cruz-Jentoft AJ, Bahat G, Bauer J et al (2018) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48:601–609
Wu G (1998) The relation between age-related changes in neuromusculoskeletal system and dynamic postural responses to balance disturbance. J Gerontol A Biol Sci Med Sci 53:M320–326
Landi F, Liperoti R, Russo A et al (2012) Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clin Nutr 31:652–658
Dent E, Morley JE, Cruz-Jentoft AJ et al (2018) International clinical practice guidelines for sarcopenia (ICFSR): screening, diagnosis and management. J Nutr Health Aging 22:1148–1161
Drey M, Ferrari U, Schraml M et al (2020) German version of SARC-F: translation, adaption, and validation. J Am Med Dir Assoc 21:747–751
Perez-Sousa MA, Venegas-Sanabria LC, Chavarro-Carvajal DA et al (2019) Gait speed as a mediator of the effect of sarcopenia on dependency in activities of daily living. J Cachexia Sarcopenia Muscle 10:1009–1015
Kortebein P, Ferrando A, Lombeida J et al (2007) Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA 297:1772–1774
Wall BT, Dirks ML, van Loon LJC (2013) Skeletal muscle atrophy during short-term disuse: implications for age-related sarcopenia. Ageing Res Rev 12:898–906
Othaka A, Aoki H, Nagata M et al (2019) Sarcopenia is a poor prognostic factor of castration-resistant prostate cancer treated with docetaxel therapy. Prostate Int 71:9–14
Fukushima H, Nakanishi Y, Kataoka M et al (2016) Prognostic significance of sarcopenia in patients with metastatic renal cell carcinoma. J Urol 195:26–32
Fukushima H, Takemura K, Suzuki H et al (2018) Impact of sarcopenia as a prognostic biomarker of bladder cancer. Int J Mol Sci 19:2999–3007
Rimar KJ, Glaser AP, Kundu S et al (2018) Changes in lean muscle mass associated with neoadjuvant platinum-based chemotherapy in patients with muscle invasive bladder cancer. Bladder Cancer 29:411–418
Kaye DR, Schafer C, Thelen-Perry S et al (2020) The feasibility and impact of a presurgical exercise intervention program (prehabilitation) for patients undergoing cystectomy for bladder cancer. Urology 145:106–112
Robertson HL, Michel C, Bartl L et al (2020) Sarcopenia in urologic oncology: identification and strategies to improve patient outcomes. Urol Oncol. https://doi.org/10.1016/j.urolonc.2020.05.001
Mayr R, Gierth M, Zeman F et al (2018) Sarcopenia as a comorbidity-independent predictor of survival following radical cystectomy for bladder cancer. J Cachexia Sarcopenia Muscle 9:505–513
Pycha A, Comploj E, Bonatti M et al (2020) Sarkopenie als Surrogatmarker für Gebrechlichkeit. UroNes 9:36–40
Layman DK (2009) Dietary Guidelines should reflect new understandings about adult protein needs. Nutr Metab (Lond) 13:6–12
Goisser S, Kemmler W, Porzel S et al (2015) Sarcopenic obesity and complex interventions with nutrition and exercise in communitydwelling older persons—a narrative review. Clin Interv Aging 10:1267–1282
Martone AM, Lattanzio F, Abbatecola AM et al (2015) Treating sarcopenia in older and oldest old. Curr Pharm Des 21:1715–1722
Law TD, Clark LA, Clark BC (2016) Resistance exercise to prevent and manage sarcopenia and dynapenia. Annu Rev Gerontol Geriatr 36:205–228
Rieu I, Balage M, Sornet C et al (2006) Leucine supplementation improves muscle protein synthesis in elderly men independently of hyperaminoacidaemia. J Physiol 575:305–315
Dillon ED, Sheffield-Moore M, Paddon-Jones D et al (2009) Amino acid supplementation increases lean body mass, basal muscle protein synthesis, and insulin-like growth factor‑I expression in older women. J Clin Endocrinol Metab 94:1630–1637
Kiesswetter E (2015) Optimierte Ernährung bei Sarkopenie. Schweiz Z Ernährungsmed 13:6–11
Watanabe Y, Madarame H, Ogasawara R et al (2013) Effect of very low-intensity resistance training with slow movement on muscle size and strength in healthy older adults. Clin Physiol Funct Imaging 34:463–470
Belavy DL, Beller G, Armbrecht G et al (2011) Evidence for an additional effect of whole-body vibration above resistive exercise alone in preventing bone loss during prolonged bed rest. Osteoporos Int 22:1581–1591
Kemmler W, von Stengel S (2012) Alternative exercise technologies to fight against sarcopenia at old age: a series of studies and review. J Aging Res 2012:109013. https://doi.org/10.1155/2012/109013
Brass EP, Sietsema KE (2011) Considerations in the development of drugs to treat sarcopenia. J Am Geriatr Soc 59:530–535
Kilsby AJ, Sayer AA, Witham MD (2017) Selecting potential pharmacological interventions in sarcopenia. Drugs Aging 34:233–240
Wakabayashi H, Sakuma K (2014) Comprehensive approach to sarcopenia treatment. Curr Clin Pharmacol 9:171–180
Becker C, Lord SR, Studenski SA et al (2015) Myostatin antibody (LY2495655) in older weak fallers: a proof-of-concept, randomised, phase 2 trial. Lancet Diabetes Endocrinol 3:948–957
Smith RC, Lin BK (2013) Myostatin inhibitors as therapies for muscle wasting associated with cancer and other disorders. Curr Opin Support Palliat Care 74:352–360
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
H.J. Heppner und H. Hag geben an, dass kein Interessenkonflikt besteht. Forschungsunterstützung von ThermoScience, Forschungskolleg Geriatrie der Robert-Bosch-Stiftung, Wissenschaftsforum Geriatrie, Deutsche Bank, Innovationsfonds des GBA; Vortragshonorare von Pfizer Pharma, Bayer Health Care, Bayrische Landesärztekammer (München), AO Trauma Europe, Novartis.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
Additional information
QR-Code scannen & Beitrag online lesen
Rights and permissions
About this article
Cite this article
Heppner, H.J., Hag, H. Sarkopenie: ein geriatrisches Syndrom mit Bedeutung für die Urologie. Urologe 61, 13–17 (2022). https://doi.org/10.1007/s00120-021-01703-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00120-021-01703-5